Ten Things You May Not Know about ADHD

Hello, good people. My name is Dr. K, and welcome to Mental Health | Plain Speak.  I’m a psychiatrist in the Southeast, and my goal with these talks is to provide easy to access information on mental health.  Thanks for joining me today for part two of the talk “Ten Things You May Not Know About ADHD.”  First, I want to offer you a little bit of a refresher--ADHD stands for Attention Deficit-Hyperactivity Disorder.  Recent studies report that it affects about 10-11% of children and about 3-5% of adults in the United States.  In the last session, we highlighted that ADHD is a disorder that affects the way the brain develops.  We also discussed that ADHD tends to run in families, and it’s helpful for all family members with ADHD—parents included—to get treatment for the condition.  We also emphasized that treatment for ADHD has multiple components including medication management, various types of therapy, and educational supports.  Furthermore, we discussed how identifying the right medication for treatment of ADHD may be similar to trying on shoes—there is a need to find just the right fit.  We also highlighted that parents with ADHD need to realize they may very well need to work more diligently to help bring out the best in their child. 

Now, to move forward with the new information I’d like to present today—on the list of ten things you may not know about ADHD, we’re on number six. 

So, number six—you probably inferred this from the tips I gave to parents, but I wanted to state this clearly and explicitly---ADHD is not just a disorder of childhood and adolescence.  Symptoms of ADHD may persist into adulthood.  And much more often than not, they do persist.  Most children with ADHD won’t outgrow the disorder based on a recent study.  In fact, the results of the study suggested that over 90% of individuals with childhood ADHD will continue to struggle with residuals symptoms and impairments of ADHD at least into young adulthood.  

And that brings me to number seven--in order to receive the diagnosis of ADHD as an adult, you must have demonstrated symptoms of ADHD before age 12.  When I am evaluating an adult for ADHD, I actually strive to rule out any medical causes for struggles with focus.  Then I reach out to the adult patient’s parents or seek past records that would indicate the presence of ADHD symptoms before age 12.  If a person has the onset of problems with attention, concentration, or focus during adulthood but never had them as a child, then by definition, it is not ADHD.  Another reason for the problems with focus must be sought out. 

And moving on to the eighth thing you may not know about ADHD—emotional dysregulation and lack of motivation are two huge components of ADHD.  And what I mean is this: people who have ADHD may have real struggles with controlling their emotions and the behaviors triggered by strong emotions.  Kids with ADHD often get in trouble for laughing excessively or too loud at seemingly inappropriate times, and they really can’t seem to stop.  This is connected to their brains’ lack of ability to control and regulate their behavior in response to emotions.  Individuals with ADHD often seem to overreact.  Often times, they don’t tolerate hearing the word “no” and may fly off the handle if they don’t get their way.  Individuals with ADHD may be more prone to “snap” or to get aggressive, and they may have a hard time calming down.  Again, this is related to the differences in brain development that results from ADHD.  Medications for the treatment of the core symptoms of ADHD can also benefit the emotional dysregulation component, but sometimes, other medications like antidepressants or mood stabilizers may be needed to help individuals with ADHD gain greater control over their emotions and behaviors. 

People with ADHD also really struggle with motivation to do the things that they know they need to do, especially if they think a task is going to be boring, tedious, or overwhelming.  As a result, they are often labeled as “lazy.”  As we mentioned before, ADHD is understood to result, at least in part, to changes in brain chemistry, specifically one particular brain chemical—dopamine.  Dopamine is a chemical that helps a person to experience pleasure during an activity.  With ADHD, there appears to be a deficiency of dopamine and a disruption of dopamine pathways so that people with the disorder do not experience the sense of reward or positive feedback that others without ADHD experience when doing a task.  This may result in frequent complaints of boredom and lack of motivation to do much of anything unless an individual thinks the task will be intensely pleasurable, rewarding or gratifying.  So, people struggling with symptoms of ADHD are not “lazy.”  They simply don’t derive the same type of pleasure or gratification from completing mundane tasks that others do and therefore are reluctant to engage in mundane day-to-day activities.   

The ninth thing you may not know about ADHD—if ADHD is left untreated, the outcome can be devastating and dismal.  And here’s the lowdown:   

Children with untreated ADHD may have significant struggles with learning and may fall behind and get poor grades.  They may constantly get in trouble at school for failing to follow instructions or complete assignments.  They may get in significant trouble for their impulsive behavior.  Often times, they are sent to the principal’s office, suspended, or even expelled for saying inappropriate things or disrupting the class with their behavior.  As a result of getting in so much trouble from parents and teachers, kids with untreated ADHD struggle with self-esteem.  Also, because of their struggles with regulating their emotions, they may have problems in their relationships with other kids as well as with teachers and their parents.  They may have a hard time keeping friends.  Experiences like these may contribute to the development of symptoms of depression or anxiety.  Kids with untreated ADHD—because of their hyperactive and impulsive behavior, are also more prone to accidents and wind up visiting the emergency room more frequently.   Several years ago, I saw a young boy in the ER who had ADHD and had not been receiving treatment.  He had fiery red abrasions that coursed around his neck.  We discovered that the boy had watched a scary movie on TV where a character hanged himself.  He’d tried to imitate what he saw on TV, wrapped the cords of the window blinds around his neck and jumped off of a table. 

Teens with untreated ADHD are much more likely to abuse drugs and engage in risky sexual behavior.  Women with ADHD had a sixfold higher odds of giving birth before age 20.   

If ADHD continues to be untreated during adulthood, half of the adults go on to develop a substance use disorder at some point in their lives.  People with untreated ADHD are less likely to graduate from high school or college and have difficulty having stable income.  They may also struggle with holding down a job because of their inability to focus and complete tasks at work. Adults with untreated ADHD have higher rates of divorce and higher mortality rates. 

Okay, y’all.  I know all this information really sounds dark and dismal, but I want you to begin to understand the importance of seeking treatment for ADHD. 

I do want to end on a positive note and say this: 

The number ten thing that you may not know about ADHD is this: 

I personally believe that ADHD is a package deal.  And this is what I mean:  it seems to me that individuals with ADHD may very well have deficits in some areas, but amazing surpluses in others.  I’ve noticed that individuals with ADHD are wonderfully talented--particularly in the areas of the arts, athletics, everything outdoors, and in endeavors that require substantial energy and risk.  In the pool of individuals who struggle against symptoms of ADHD, you’ll find extraordinary musicians and vocalists, makeup artists, fashionistas and fashion designers.  You’ll find chefs, actors, comedians, visual artists, graphic designers, and writers.  You’ll find dancers and creators of all sorts.  You’ll also find dynamic athletes who can push themselves to limits of what is humanly possible.  They are the marathon runners and mountain scalers.  How many Olympic athletes can you name that have been diagnosed with ADHD?  There are several.  Amongst those struggling against ADHD, you’ll find fitness gurus, athletic trainers, and those who excel in martial arts.  And you’ll find outdoorsmen---people who fair best in the rugged and wild.  You’ll find those who love to hunt and fish and hike and bike, and ride horseback anytime they can.  You’ll find the folk who just can’t just get enough of woods and streams and mountains. 

I’ve had patients absolutely bowl me over with displays of their talents.  Sometimes, they’d come into the clinic dressed to the nines, and I am like—oh my goodness.  That outfit is amazing!  I would have never thought to put that together, but it works!  I’ve been amazed by the artistry that they display in making up their faces.  I mean flawless makeup—beautiful layering of eye shadow--all the things!  Patients I’ve treated for ADHD have shared with me poems, stories, and songs they’ve written.  I’ve watched them dance, play the piano, and perform excerpts from theatrical pieces, and I’ve been moved to tears by their skills and talents.  Oh, and let me not forget, you’ll find in this pool of individuals who struggle against ADHD—you'll find the humanitarians.  People diagnosed with ADHD are some of the most compassionate, encouraging, patient and nurturing individuals I know.  Individuals diagnosed with ADHD are often outgoing and people or animal-oriented.  In this pool are counselors and teachers and clergy and healers.  They are the caretakers.  They are the rescuers of humans and animals alike.  They are the first-responders.  They are the ones who fight for the underdog.     

Managing ADHD can come with its share of challenges, but it can also come with an extraordinary set of gifts.  Research has shown that employees with ADHD can be more creative, curious, imaginative, inventive, and innovative.  Their out-of-the-box thinking can be a strength in the workplace.  Their seemingly bottomless amounts of energy can be a true asset in many settings. 

Alright, guys--that’s the end of the session for today.  I hope this content has shed some light on things you may not have fully understood or appreciated about ADHD.   

Keep in mind that the suggestions I offer here are not meant to be a substitute for advice from your own provider.  Folks, let’s make it our business to understand mental illness and those who struggle against mental illness.  I’m Dr. K, and this has been Mental Health | Plain Speak.  And remember, “Be kind, for everyone you meet is fighting a hard battle.”